the Age of the Mega-Hospital is ending
For over a century, healthcare has revolved around big hospitals; massive central hubs where patients with almost every need are treated. That era is starting to wane. Around the world, we are seeing a shift toward tech-enabled, decentralised healthcare. Instead of mega-hospitals handling everything under one roof, healthcare is moving beyond “hospital walls” and physically closer to where people live (Philips Research, n.d.).
Virtual-first clinics, community diagnostics, hospital-at-home programmes, mobile surgical units, and even retail health hubs are rising up as alternatives to the old hospital-centric model. In short, healthcare is becoming “healthcare without walls”, with services delivered at home, in local clinics, or via apps, not just in big buildings downtown (Pampin, 2023). This transformation is driven by technology, demographics, and a need for more accessible, sustainable care. It’s a profound change that could reshape patient experiences and outcomes for the better.
Source: MaRS, 2014
The Problem with Big Hospitals
Large centralised hospitals have undeniable capabilities, but they also come with serious drawbacks. Cost and sustainability, patient experience, and accessibility issues are major concerns.
Cost and Sustainability of the Mega-hospital
Building and operating mega-hospitals is incredibly resource-intensive. The global healthcare sector already produces roughly 4–5% of worldwide greenhouse gas emissions (Dutchen, 2023). Financially, many health systems are finding that the cost of care is becoming unsustainable (Pampin, 2023). As populations age and chronic diseases rise, simply pouring more money into big hospitals isn’t solving the problem. In fact, hospital capacity in many places is shrinking, not growing, because it’s so expensive to expand and staff these facilities (Pampin, 2023).
We face Finite Resources of funding, equipment, and trained staff, and the traditional model is straining those limits. Embracing Strong Sustainability principles means recognising we can’t keep expanding physical infrastructure at the expense of natural resources and future generations. These values are part of the 12 Foundational Focus Factors (FFFs) of the THRIVE Frameworks’ Systemic Holistic Model, which allows a path towards addressing sustainability challenges in the modern world and moving from sustainability to thrivability.
Sacrificing patient experience
Beyond costs, patient experience in giant hospitals often leaves much to be desired. Patients frequently dislike the impersonal atmosphere, long waits, and bureaucracy of large hospitals (Maier, 2025).
A hospital stay can be stressful and even risky; exposure to hospital-acquired infections, medical errors, and the general discomfort of being away from home can all harm patient well-being (Maier, 2025).
In big institutions, care can feel fragmented; one hand might not know what the other is doing. This is especially problematic when considering Complex Wicked Problems in healthcare (like managing multiple chronic conditions), which require coordinated, patient-centred approaches.
Accessibility issues of centralised care
There’s also an accessibility issue with centralised hospitals. If you live far from the city or in a rural area, that big regional hospital might as well be on another planet when you need a simple check-up or diagnostic test.
For many, distance and travel logistics become barriers to care. In contrast, a more distributed system promises care that meets people where they are, potentially reducing inequalities between urban and rural health services.
What’s Emerging instead
In response to these challenges, a new healthcare delivery ecosystem is taking shape. It’s distributed, tech-enabled, and closer to home.
Source: Philips Research, n.d.
Virtual-First Clinics
Many healthcare providers now offer telehealth as the front door to care. Patients might first consult a doctor via video or a smartphone app. Routine check-ups, follow-ups, mental health sessions, and even some urgent care can be handled virtually. Virtual care adoption soared 38-fold during the COVID-19 pandemic, and while in-person visits remain important, virtual care has secured its own space (Philips Research, n.d.). It particularly helps those with mobility issues or living in remote areas by making competent care more accessible from home (Pampin, 2023).
Considering a Systems Thinking view, virtual care is one part of an interconnected solution. It works best when it’s integrated with physical services, so data and patient information flow seamlessly between online and offline providers.
Community-Based Diagnostics and Clinics
Instead of asking patients to come to a hospital for every blood test or X-ray, healthcare is popping up in the community. Retail health hubs are a prime example. Pharmacy chains and retailers are opening clinics in shopping centres, drugstores, and supermarkets. In the United States, CVS and Walgreens have been transforming some stores into HealthHUBs and clinics, offering services such as primary care, vaccinations, lab tests, and even managing chronic conditions (Landi, 2022).
The idea is to bring healthcare to convenient places; your local shopping centre or your doorstep, instead of funnelling everyone into a central hospital (Pampin, 2023).
Hospital-at-Home Programmes
Perhaps the most groundbreaking change is the resurgence of care in the home. What sounds old-fashioned (doctors making house calls) has been reinvented with modern technology and logistics. Hospital-at-home (HaH) programmes allow certain patients to receive acute, hospital-level treatment while staying in their own bedrooms. Equipped with remote monitoring devices, on-call medical teams, and daily visits from nurses or paramedics, patients can be treated for conditions like pneumonia, heart failure, or infections without being admitted to a hospital ward.
This model got a huge boost during COVID-19, when keeping patients out of crowded hospitals was a necessity. In the United States, a special waiver programme by Medicare supported hospitals in deploying acute care at home. The result has been eye-opening: research suggests that 30–40% of all hospital care could potentially be moved into patients’ homes with no loss of quality (American Hospital Association, n.d.). Dozens of conditions can be safely managed at home with today’s technology and a well-designed protocol. This not only expands capacity (every home becomes a “bed”) but often improves patient comfort.
Mobile Units and Micro-Hospitals
Taking a page from disaster response and military medicine, healthcare providers are deploying mobile clinics and surgical units. These are essentially hospitals on wheels, vans, or trailers outfitted with exam rooms, imaging devices, or even operating theatres for minor surgeries. They can drive out to underserved communities, rural areas, or be stationed at public events to provide on-demand care.
Alongside mobile units, we also see the rise of micro-hospitals or small specialty clinics. These facilities have a smaller footprint and a limited scope (e.g. an outpatient surgery centre or a birthing centre), but they are distributed so people don’t all crowd into one big hospital for those services. They are connected by digital records and referral networks to larger hospitals for anything they can’t handle.
Integrated Data and AI
One thing making all the above models possible is the digital glue holding them together. Modern healthcare generates a lot of data, from your electronic health records to your smartwatch’s heart rate logs. In a distributed care model, integrating data across settings is critical (Philips Research, n.d.). If you do a lab test at a pharmacy clinic, have a telehealth consult, and later get admitted to a hospital-at-home programme, all those sets of data should inform one another. Health systems are increasingly adopting cloud platforms and IoT (Internet of Things) devices to track patient metrics wherever care happens.
In essence, technology ensures that this new network of care is coordinated; a Systems Thinking approach where each element (virtual clinic, retail hub, and home programme) is linked into one continuum.
Source: Jaro Education, 2024
From Mega-Hospitals to a Decentralised healthcare system
Together, these emerging models create a “distributed network of care” (Philips Research, n.d.). Instead of one mega-hospital providing all services, we have an ecosystem: the hospital is still there, but focuses on what it does best (complex surgeries, intensive care, advanced diagnostics). Meanwhile, many other needs are met by smaller, more agile services in the community or online.
This networked approach can be more resilient too, if one node is overwhelmed (e.g. a hospital ICU during a pandemic), other nodes like telehealth and home care can take on more load. It’s akin to moving from a single supercomputer to a distributed cloud: more flexible, scalable, and closer to the end-user.
A Healthier Future: Decentralised healthcare, Better outcomes?
A big question is whether this shift actually leads to better outcomes for patients. Early evidence is promising. When done thoughtfully, decentralised healthcare can improve quality and patient satisfaction. Hospital-at-home programmes, for instance, have demonstrated striking benefits. Studies have found that patients receiving acute care at home often have shorter recoveries, lower readmission rates, and fewer complications than those in the hospital (American Hospital Association, n.d.).
Home patients avoid the risks of hospital-acquired infections and can sleep in their own beds. In one trial, the HaH model led to higher patient and family satisfaction, fewer delirium episodes, fewer unnecessary tests, and 30% lower costs compared to traditional hospital stays (Maier, 2025). That’s a win–win: patients heal better and the system saves money. Telehealth and community clinics likewise report positive outcomes in many cases. Telemedicine has been shown to improve access and continuity of care, which is crucial for managing chronic illnesses.
In one trial, the HaH model led to higher patient and family satisfaction, fewer delirium episodes, fewer unnecessary tests, and 30% lower costs compared to traditional hospital stays (Maier, 2025).
There’s also a strong argument that a smaller physical footprint can translate into a smaller environmental footprint, aligning with a Regenerative Economy approach. A network of smaller clinics and home care might use fewer resources than constructing and maintaining giant hospital complexes (which require enormous energy, water, and materials). If patients don’t always have to drive long distances to a central hospital, transportation emissions can also be reduced. In healthcare, as in other sectors, thinking about Strong Sustainability means striving for solutions that not only do less harm but actively improve well-being. A community health hub in a shopping centre might revitalise that community and encourage healthy lifestyles around it, effectively regenerating social and health capital locally.
Risks and Challenges of the Decentralised Healthcare
No major change comes without pushback and potential pitfalls.
Quality & Safety
One concern is quality and safety: can these dispersed models maintain high standards of care? Sceptics worry that breaking up services might lead to fragmentation. If you get your blood test at a retail clinic, see a specialist via telehealth, and are later admitted to a micro-hospital, who ensures that all those pieces come together? Good coordination (and interoperable data) is critical to avoid things falling through the cracks. Healthcare providers are working on these integration challenges, but it remains a complex problem to solve at scale.
Cybersecurity & Privacy
Another risk is cybersecurity and privacy. Distributed healthcare often relies on connected devices and internet-based services. That opens new avenues for cyberattacks or data breaches. A home health monitor or a virtual visit platform could be targeted if not properly secured. Patients need confidence that their personal health data remains confidential and safe across all these new channels.
Internal Resistance
There’s also resistance from within the healthcare system. Large hospitals and the organisations that run them might fear revenue loss if too much care shifts outwards. After all, hospitals often rely on income from surgeries and tests; if those move to clinics or homes, the hospital’s business model must adapt. Some clinicians are understandably cautious as well. The training and culture of medicine have long centred on hospitals as the place of “real” care. Shifting to home or retail environments requires new protocols, and not all providers are comfortable with that initially.
Regulation & Reimbursement
Many healthcare systems (and insurers) were built around paying for in-hospital treatments. It’s taken special waivers and policy changes to pay for telehealth visits or hospital-at-home services in some countries. Policymakers will need to update laws to support these innovations permanently, otherwise the old model’s financial incentives will pull back toward centralisation.
External resistance
Finally, we must consider the human element. Not every patient is tech-savvy or even has reliable internet. Digital health can inadvertently exclude those who lack devices or skills (often older or lower-income individuals), exacerbating the very disparities we aim to reduce.
Ensuring equity in a distributed model means providing alternatives and assistance so that no one is left behind (for instance, maintaining some in-person options or community health workers to help patients navigate new tools). And while many patients appreciate the convenience of at-home or retail care, some still crave the reassurance of a traditional hospital for serious issues.
In summary, the shift away from mega-hospitals brings risks that must be managed. The key is to design distributed care so that it is safe, inclusive, and high-quality, rather than letting market forces drive it haphazardly. Stakeholders, medical professionals, tech companies, and regulators, will need to collaborate closely. If we succeed, the benefits should far outweigh the risks.
Achieving healthcare Thrivability
The future patient experience will likely be one with more choices: virtual or in-person, home or clinic, big hospital or small speciality centre, depending on what you need. The system around you will (ideally) coordinate these pieces so it feels cohesive. You’ll still go to a large hospital if you have a severe trauma or need an ICU. But for most routine and moderate needs, you might not need to. Healthcare will come to you, instead of the other way around.
beyond net zero
Resilient Infrastructure
It’s worth framing this healthcare shift in the context of global sustainability goals. The United Nations’ Sustainable Development Goal 9 (SDG9) focuses on building resilient infrastructure, promoting inclusive industrialisation, and fostering innovation. It certainly encourages improving healthcare infrastructure (especially in developing regions) as part of building resilient communities (United Nations, n.d.). However, from a THRIVE Project perspective, which champions going beyond sustainability to thrivability, SDG9 may not be ambitious enough on its own.
Why? SDG9: Industry, Innovation and Infrastructure, and similar goals often emphasise “sustainable” infrastructure, meaning infrastructure that minimises harm and supports economic development. That’s important, but not sufficient if we truly want healthcare that helps both people and the planet to thrive. Sustainability, as typically defined, is about reaching net zero impact; thrivability is about having a net positive impact. In the healthcare context, simply building more hospitals (even “green” hospitals) under SDG9 might reduce infrastructure gaps, but it won’t automatically solve deeper issues like planetary resource limits or the social determinants of health.
Resilient Communities
Similarly to SDG9, SDG11: Sustainable Cities and Communities, from the UN, focuses on making cities and settlements “inclusive, safe, resilient, and sustainable” (United Nations, n.d). Also similar to SDG9, SDG11 doesn’t go far enough.
SDG11 promotes safe and sustainable cities, which is important, but again, it focuses mostly on reducing harm. For example, it encourages cleaner transport, better housing, and greener public spaces. These are good steps, but they still operate within a model of damage control: how can we make urban living less bad, rather than actively prosperous?
THRIVE Project calls for something more. A truly thriving city doesn’t just survive climate shocks or reduce inequality a little, it regenerates ecosystems, supports mental and physical health, and helps communities flourish. THRIVE’s toolkit aims to help us understand how everything is interconnected: health services, housing, transport, energy, and nature. Only by seeing the whole picture can we design cities and healthcare systems that truly support life.
Achieving THRIVE goals
A thrivable healthcare system would align with THRIVE’s Foundational Focus Factors (FFFs), such as Strong Sustainability, Systems Thinking, Regenerative Economy, and Science-Based Targets. Strong Sustainability reminds us that natural resources (clean air, water, and materials) are finite and irreplaceable; we can’t simply trade off environmental damage for economic gain. Thus, the move away from mega-hospitals, which are resource hogs, toward smaller distributed models is in line with respecting those finite resources.
Instead of constructing another energy-guzzling mega-building, we repurpose existing community spaces or use telehealth to reduce travel, which is a regenerative approach. It lets nature recover by reducing waste and emissions, while still delivering care. Systems Thinking, another THRIVE FFF, is crucial here. SDG9 tends to silo infrastructure as a goal, but Systems Thinking tells us to see the whole picture; how healthcare infrastructure interacts with social systems, technology, and the environment.
The THRIVE philosophy might also critique SDG9 for focusing on infrastructure rather than outcomes. It’s one thing to build clinics and hospitals (the hardware), but an obsession with infrastructure can miss the point if those facilities don’t actually make people healthier or happier. The THRIVE approach would push us to set Science-Based Targets for health outcomes and environmental impact. For example, rather than “build 10 new hospitals”, a thrivable goal might be “ensure 99% of the population can access essential care within 30 minutes, with healthcare sector emissions cut by 50%.” It’s more holistic and context-based, tailoring solutions to the needs of each region rather than a global checklist
Conclusion
Change is always challenging, especially in something as complex as healthcare. There will be trial and error. Not every virtual clinic will succeed; not every community will adapt at the same pace. But the direction is clear. The benefits, in cost, convenience, and outcomes, are too significant to ignore.
Ultimately, this is about building a healthier society on a healthier planet. The hospital of the future isn’t a single building; it’s a network, a partnership with the community, and technology. It’s an ecosystem of care that can help us not just survive, but truly thrive.
So join us and follow THRIVE’s blog, tune into our podcasts, and join webinars to hear from thought leaders and ask questions. Finally, subscribe to our newsletter to stay on top of the latest in thrivability. By staying engaged, we can ensure that our collective voice steers healthcare in a direction that is innovative and inspiring, yet also equitable, inclusive, and thrivable.
